Postpartum infections of the genital tract are due to bacteria ascending from the genital tract. Usually the infection is localized but it can spread through blood or lymph causing systemic infection. Common manifestation is fever, 39oC ( 102.2oF) at any time or 38oC (101.4oF) on two successive occasions 4 hours apart after the first 24 hours of delivery.

– Infections of the perineum and vulva: Localized infections commonly involving a perineal laceration or episiotomy wound.
– Endometritis: Localized infections from the inner uterine wall usually begin at the placental side and may spread to the entire endometrium
– Risk factors: Prolonged labor and rupture of membranes.

– Advice the client to avoid possible sources of infection especially respiratory tract infections, URTI and communicable diseases.
– Minimize visitors.
– Use separate equipments for providing care for each client.
– Careful hand washing after contact with each client.
– Personnel with an infection should not work in maternity ward.
– Clean dry masks covering nose and mouth should be worn during delivery and procedures.

– Inspect the perineum and lochia at least every 8 hours for signs of infection.
– Follow aseptic techniques while giving perineal care.
– Teach proper techniques for perineal care to the client – not touching the labia or perineal part with the fingers and not separating the labia because this permits the cleansing solution to enter the vagina.
– Teach breastfeeding mothers to inspect their nipples for redness or cracks after each feeding.
– Teach the client to report the signs and symptoms of any infection promptly.
– Early ambulation of the client to promote circulation.
– Enhance intake of fluid and a balanced diet.

Mastitis

Mastitis Definition

Infection of the glandular tissue of the breast usually caused by staphylococcus aureus and sometimes by streptococcus.

Pathophysiology of MastitisMicroorganisms enter into the ductal system through erosions of the nipple or areola. The source of infection may be from the newborn’s mouth or from the client’s fingers. The microorganisms multiply in the plugged lactiferous ducts causing infection.
– Epidemics of mastitis occur when organisms are transmitted from nursery personnel to many newborns and then to the mothers

Infection to the urinary tract is a major risk in the postpartum clients due to the physiologic urinary stasis, dilatation of the ureters and vesicoureteral reflux. If the client is unable to void fully the remaining urine in the bladder act as a good culture medium for bacteria leading to cystitis (inflammation of the bladder) and pyelonephritis (inflammation of the renal pelvis).

– Blood loss of more than 500 ml within a 24 hour period.Classification of Postpartum hemorrhage– Immediate – within 24 hours
– Delayed or late – after 24 hours, usually between 5-15th postpartum day; can be as late as 6th week.

– Emergency management: Uterine massage
– Place one hand on the symphysis pubis supporting the base of the uterus and grasp the uterine – fundus with the other hand and massage gently.– Other management– Empty the bladder
– Oxytocin infusions at a rapid rate
– Ligation of uterine vessel
– Hysterectomy if all the other measures fail.

Management of Retained placental parts
– D & C
– If placenta accreta which can not be removed treatment with methotrexate.

– Incomplete return of uterus to the prepregnant state.Treatment:– Oral methyl ergonovin (Methergin)
– If due to infection
– Antibiotic

Subinvolution of uterus

Hematoma

– Blood escaping into the tissue beneath the skin covering external genitalia or vaginal mucosa.Assessment of Subinvolution of uterus
– Severe perineal pain
– Swelling in the external genitalia or vagina. Record the size as 5 cm or 100 fils size rather than – writing small.
– Bluish-black skin– Management: If enlarging, incision, ligation of the bleeding vessel and evacuation of clot.– Nursing diagnosis and interventions of Subinvolution of uterus
– Alteration in comfort, pain related to collection of blood in the subcutaneous tissue.
– If mild, analgesics for pain.
– Cold applications.

Pulmonary embolism

– A thrombus formed in the uterine or pelvic vein enter into circulation (embolus) and occludes pulmonary artery.
Blood flow to the lungs is obstructed and sudden death can occur.
If the embolus is amniotic fluid the condition is called amniotic fluid embolism.

Infection of the veins of the leg with clot formation. Ovarian and pelvic veins also may be included.Assessment of Thrombophlebitis– Pain in the groin or hips and extending downward.
– Stiffness.
– Pale skin.
– Swelling of the calf or thigh
– Malaise
– Chills.
– Fever.